The opinions and photographs within this web page are not ours.
Authors have been credited for the individual posts where they are.
- www.rxroots.com Photos courtesy of Ahmad Tehrani
From: Ahmad Tehrani
To: ROOTS
Sent: Friday, April 28, 2006 12:26 AM
Subject: [roots] super-erupted molar
#30, Irrev. pulpitis with periradicular periodontitis. Gross
carious lesion and super-erupted opposing the missing lower first molar. Her
symptoms disappeared after initiail caries control, pulpectomy and CH dressing.
10 days later she was pain free and case completed with warm GP obturation/Kerr
sealer. flowable composite to seal the orifice and a bonded amalgam for buildup.
- ahmad
I'm trying to lean from you and others. I wonder how you decided to not look more
for another mb canal? I am so dumb, I would keep searching in the mesial toward
the central lateral area with my Pizon I would perf. The endo looks very nice
AND i WISH i COULD DO AS WELL. i ALSO USE A SCOPE, BUT OF LATE MY NECK KEEPS ME
LIMITED. sometimes IS IT POSSIBLE, AS HERE TO LOOK TO MUCH? - Alan
PS sorry about the cap lock.
Nice case Ahmad! - Randy
Ahmad,Was this tooth vital ?
Periradicular Periodontitis ? Can you explain to me how do you diagnose this,
as I never heard such a term - Thomas
P.S No MB2 ?
Nice amad. Classic case of extracted lower beget supereruption which beget food
impaction which beget distal caries which beget endo which will soon beget a crown.
Mb2 or no? - gary
Hi Tommy: Periapical= Periradidular.
the tooth was tender to percussion at the initial appointment.
Mesial canal had a wide orifice coronally.
and I troughed the line to the palatal and moved the wall toward mesial.
No separate orifice...and the white line disappeared, so I decided not to perf the
floor inadvertently.
I am not saying it is not there, but I looked for a total of 4 hours and couldn't
find it. could be just me...(( - ahmad
It's the "new" terminology
In the old days we told the patient they had an "abscess"
This is strictly NOT true - As an abscess is an accumulaton of pus
The radiograph may show bone loss but a periapical radiolucency does not equate
to an accumulation of pus
So when you see that dark area now you can use fancy latin words
Its AP apical periodontitis (swelling of the tooth joint at the end of the root)
This could be AAP or CAP
Acute apical periodontitis or
Chronic apical peroidontitis
BUT don't confuse this with CRAP = Chronic radicular apical pus - Jeremy Rourke
Lol. We were always taught 3 possible apical scenarios
1.abscess-accumulation of purulent exudate
2.granulation tissue (or more correctly granulomatous tissue)- most closely
associated with ap now I suppose
3.radicular cyst.
I’m beginning to think that the endodontic vernacular inclined had their origins
in the military with their affinity for acronyms - gary
I still see no "Periradicular Periodontitis" in your terminology.
There is reason I asked the question - Thomas
Ahmad, There is no such thing as "periapical periodontitis" in diagnosis. As far
as I know, there is "acute p.a" or "chronic p.a" but not "p.a" alone. P.A alone
doesn't give us enough information.
I don't through the line towards palatal much nowadays, mostly move the wall to mesial.
I think you didn't move the wall mesialy enough, what do others think ? The canals
look really big, so it's possible there is no MB2 but I doubt it. In my experience,
MB2 exists almost allways, we just don't allways find it. 4 hours is a lot of time.
Who said endo is easy :( - Thomas
P.S Very nice teaching case and excellent documentation as allways !
Ok Tommy: I am kind of slow sometimes...(( It was acute periodontitis.
but to be honest with you, I could never understand the significance of it...and what
changes in the treatment plan protocol it signifies. All symptomatic teeth in my
practice get ca(OH)2 until they become asymptomatic or the ST closes
how do you distinguish between an acute or a chronic PA? is pain and intensity of
it the determinant factor?
Would a radiographic radiolucency make it a chronic situation?
if sinus tract present? what if there is a PA lesion, without a ST?
How about one without a lesion on Xray and no ST?
If it takes the breakdown of at least one cortical plate for a lesion to show up
radiographically...is it chronic or acute?
IOW, just because it is not visible on the xray, doesn't mean it is not there and
we can never be sure how long it's been there
....so is it chronic or acute? - ahmad
ps....I am not going to be on the computer for a while..I will back later on.
Super erupted molarI'm trying to lean from you and others. I wonder how you decided to not look more for another mb canal? I am so dumb, I would keep searching in the mesial toward the central lateral area with my Pizon I would perf. The endo looks very nice AND i WISH i COULD DO AS WELL. i ALSO USE A SCOPE, BUT OF LATE MY NECK KEEPS ME LIMITED. sometimes IS IT POSSIBLE, AS HERE TO LOOK TO MUCH? - Alan PS sorry about the cap lock. Nice case Ahmad! - Randy Ahmad,Was this tooth vital ? Periradicular Periodontitis ? Can you explain to me how do you diagnose this, as I never heard such a term - Thomas P.S No MB2 ? Nice amad. Classic case of extracted lower beget supereruption which beget food impaction which beget distal caries which beget endo which will soon beget a crown. Mb2 or no? - gary Hi Tommy: Periapical= Periradidular. the tooth was tender to percussion at the initial appointment. Mesial canal had a wide orifice coronally. and I troughed the line to the palatal and moved the wall toward mesial. No separate orifice...and the white line disappeared, so I decided not to perf the floor inadvertently. I am not saying it is not there, but I looked for a total of 4 hours and couldn't find it. could be just me...(( - ahmad It's the "new" terminology In the old days we told the patient they had an "abscess" This is strictly NOT true - As an abscess is an accumulaton of pus The radiograph may show bone loss but a periapical radiolucency does not equate to an accumulation of pus So when you see that dark area now you can use fancy latin words Its AP apical periodontitis (swelling of the tooth joint at the end of the root) This could be AAP or CAP Acute apical periodontitis or Chronic apical peroidontitis BUT don't confuse this with CRAP = Chronic radicular apical pus - Jeremy Rourke Lol. We were always taught 3 possible apical scenarios 1.abscess-accumulation of purulent exudate 2.granulation tissue (or more correctly granulomatous tissue)- most closely associated with ap now I suppose 3.radicular cyst. I’m beginning to think that the endodontic vernacular inclined had their origins in the military with their affinity for acronyms - gary I still see no "Periradicular Periodontitis" in your terminology. There is reason I asked the question - Thomas Ahmad, There is no such thing as "periapical periodontitis" in diagnosis. As far as I know, there is "acute p.a" or "chronic p.a" but not "p.a" alone. P.A alone doesn't give us enough information. I don't through the line towards palatal much nowadays, mostly move the wall to mesial. I think you didn't move the wall mesialy enough, what do others think ? The canals look really big, so it's possible there is no MB2 but I doubt it. In my experience, MB2 exists almost allways, we just don't allways find it. 4 hours is a lot of time. Who said endo is easy :( - Thomas P.S Very nice teaching case and excellent documentation as allways ! Ok Tommy: I am kind of slow sometimes...(( It was acute periodontitis. but to be honest with you, I could never understand the significance of it...and what changes in the treatment plan protocol it signifies. All symptomatic teeth in my practice get ca(OH)2 until they become asymptomatic or the ST closes how do you distinguish between an acute or a chronic PA? is pain and intensity of it the determinant factor? Would a radiographic radiolucency make it a chronic situation? if sinus tract present? what if there is a PA lesion, without a ST? How about one without a lesion on Xray and no ST? If it takes the breakdown of at least one cortical plate for a lesion to show up radiographically...is it chronic or acute? IOW, just because it is not visible on the xray, doesn't mean it is not there and we can never be sure how long it's been there ....so is it chronic or acute? - ahmad ps....I am not going to be on the computer for a while..I will back later on.
